Biparametric prostate MRI and clinical indicators predict clinically significant prostate cancer in men with “gray zone” PSA levels

Wei, Chaogang; Chen, Tong; Zhang, Yue-Yue; Pan, Peng; Dai, Guangcheng; Yu, Hai Zhou; Yang, Shuo; Jiang, Zhen; Tu, Jian; Lu, Zhihua; Shen, Jing; Zhao, Wei

doi:10.1016/j.ejrad.2020.108977

Cited by 14 publications

(46 citation statements)

References 31 publications

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“…Despite the high sensitivity of T2WI score in the diagnosis of csPCa (Table 4), benign lesions like BPH, prostatic nodules, and prostatitis can also present as low signal appearance (44,45). Regarding the bpMRI results, the Total score for PCa and csPCa detection achieved the highest prediction accuracy in both the training group and the validation group, and the AUCs were significantly higher than the PI-RADS score of bpMRI reported in other studies (0.771-0.830) (21,46,47).…”

Section: Discussionmentioning

confidence: 60%

Modified Predictive Model and Nomogram by Incorporating Prebiopsy Biparametric Magnetic Resonance Imaging With Clinical Indicators for Prostate Biopsy Decision Making

Pan

Cao

et al. 2021

Front. Oncol.

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PurposeThe purpose of this study is to explore the value of combining bpMRI and clinical indicators in the diagnosis of clinically significant prostate cancer (csPCa), and developing a prediction model and Nomogram to guide clinical decision-making.MethodsWe retrospectively analyzed 530 patients who underwent prostate biopsy due to elevated serum prostate specific antigen (PSA) levels and/or suspicious digital rectal examination (DRE). Enrolled patients were randomly assigned to the training group (n = 371, 70%) and validation group (n = 159, 30%). All patients underwent prostate bpMRI examination, and T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) sequences were collected before biopsy and were scored, which were respectively named T2WI score and DWI score according to Prostate Imaging Reporting and Data System version 2 (PI-RADS v.2) scoring protocol, and then PI-RADS scoring was performed. We defined a new bpMRI-based parameter named Total score (Total score = T2WI score + DWI score). PI-RADS score and Total score were separately included in the multivariate analysis of the training group to determine independent predictors for csPCa and establish prediction models. Then, prediction models and clinical indicators were compared by analyzing the area under the curve (AUC) and decision curves. A Nomogram for predicting csPCa was established using data from the training group.ResultsIn the training group, 160 (43.1%) patients had prostate cancer (PCa), including 128 (34.5%) with csPCa. Multivariate regression analysis showed that the PI-RADS score, Total score, f/tPSA, and PSA density (PSAD) were independent predictors of csPCa. The prediction model that was defined by Total score, f/tPSA, and PSAD had the highest discriminatory power of csPCa (AUC = 0.931), and the diagnostic sensitivity and specificity were 85.1% and 87.5%, respectively. Decision curve analysis (DCA) showed that the prediction model achieved an optimal overall net benefit in both the training group and the validation group. In addition, the Nomogram predicted csPCa revealed good estimation when compared with clinical indicators.ConclusionThe prediction model and Nomogram based on bpMRI and clinical indicators exhibit a satisfactory predictive value and improved risk stratification for csPCa, which could be used for clinical biopsy decision-making.

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Section: Discussionmentioning

confidence: 60%

Modified Predictive Model and Nomogram by Incorporating Prebiopsy Biparametric Magnetic Resonance Imaging With Clinical Indicators for Prostate Biopsy Decision Making

Pan

Cao

et al. 2021

Front. Oncol.

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“…Recently, bi-parametric (bp) MRI (a combination of T2WI and DWI) has been proposed as an alternative to mpMRI with gadoliniumenhanced sequences, reducing the costs and potential side effects of gadolinium-based contrast agents [9][10][11]. According to a meta-analysis based on the PI-RADS v2 criteria, both methods achieve a comparable diagnostic performance for csPCa [12].…”

Section: Introductionmentioning

confidence: 99%

Synthetic magnetic resonance imaging for primary prostate cancer evaluation: Diagnostic potential of a non-contrast-enhanced bi-parametric approach enhanced with relaxometry measurements

Arita

Akita

Fujiwara

et al. 2022

European Journal of Radiology Open

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“…Hence, it is necessary to combine the PI-RADS v2.1 score with clinical indicators in order to better improve the diagnostic performance for TZ cs-PCa. Most studies have focused on the diagnostic value of combining PI-RADS v2 with clinical indicators and demonstrated that adding these clinical indicators to the PI-RADS v2 score could improve diagnostic performance for the assessment of PCa or cs-PCa [ 18 – 20 ]. A recent study from Han et al has compared the diagnostic performance of bp-MRI and mp-MRI using PI-RADS v2.1 combined with PSAD in detecting cs-PCa patients with PSA 4-10 ng/mL [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

The Role of PSA Density among PI-RADS v2.1 Categories to Avoid an Unnecessary Transition Zone Biopsy in Patients with PSA 4-20 ng/mL

Wang

Wei

Zhang

et al. 2021

BioMed Research International

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Objective. To evaluate the role of prostate-specific antigen density (PSAD) in different Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) categories to avoid an unnecessary biopsy in transition zone (TZ) patients with PSA ranging from 4 to 20 ng/mL. Materials and Methods. In this retrospective and single-center study, 333 biopsy-naïve patients with TZ lesions who underwent biparametric magnetic resonance imaging (bp-MRI) were analyzed from January 2016 to March 2020. Multivariate logistic regression analyses were performed to determine independent predictors of clinically significant prostate cancer (cs-PCa). The receiver operating characteristic (ROC) curve was used to compare diagnostic performance. Results. PI-RADS v2.1 and PSAD were the independent predictors for TZ cs-PCa in patients with PSA 4-20 ng/mL. 0.9% (2/213), 10.0% (7/70), and 48.0% (24/50) of PI-RADS v2.1 score 1-2, 3, and 4-5 had TZ cs-PCa. However, for patients with PI-RADS v2.1 score 1-2, there were no obvious changes in the detection of TZ cs-PCa (0.8% (1/129), 1.3% (1/75), and 0.0% (0/9)) combining with different PSAD stratification ( PSAD < 0.15 , 0.15-0.29, and ≥0.30 ng/mL/mL). For patients with PI-RADS v2.1 score ≥ 3 , the TZ cs-PCa detection rate significantly varied according to different PSAD stratification. A PI-RADS v2.1 score 3 and PSAD < 0.15 and 0.15-0.29 ng/mL/mL had 8.6% (3/35) and 3.7% (1/27) of TZ cs-PCa, while a PI-RADS v2.1 score 3 and PSAD ≥ 0.30 ng / mL / mL had a higher TZ cs-PCa detection rate (37.5% (3/8)). A PI-RADS v2.1 score 4-5 and PSAD <0.15 ng/mL/mL had no cs-PCa (0.0% (0/9)). In contrast, a PI-RADS v2.1 score 4-5 and PSAD 0.15-0.29 and ≥0.30 ng/mL/mL had the highest cs-PCa detection rate (50.0% (10/20), 66.7% (14/21)). It showed the highest AUC in the combination of PI-RADS v2.1 and PSAD (0.910), which was significantly higher than PI-RADS v2.1 (0.889, P = 0.039 ) or PSAD (0.803, P < 0.001 ). Conclusions. For TZ patients with PSA 4-20 ng/mL, PI-RADS v2.1 score ≤ 2 can avoid an unnecessary biopsy regardless of PSAD. PI-RADS v2.1 score ≥ 3 may avoid an unnecessary biopsy after combining with PSAD. PI-RADS v2.1 combined with PSAD could significantly improve diagnostic performance.

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Biparametric prostate MRI and clinical indicators predict clinically significant prostate cancer in men with “gray zone” PSA levels

Cited by 14 publications

References 31 publications

Modified Predictive Model and Nomogram by Incorporating Prebiopsy Biparametric Magnetic Resonance Imaging With Clinical Indicators for Prostate Biopsy Decision Making

Modified Predictive Model and Nomogram by Incorporating Prebiopsy Biparametric Magnetic Resonance Imaging With Clinical Indicators for Prostate Biopsy Decision Making

Synthetic magnetic resonance imaging for primary prostate cancer evaluation: Diagnostic potential of a non-contrast-enhanced bi-parametric approach enhanced with relaxometry measurements

The Role of PSA Density among PI-RADS v2.1 Categories to Avoid an Unnecessary Transition Zone Biopsy in Patients with PSA 4-20 ng/mL

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